Repair of distal phalanx finger wound with modified great toe fibular flap with distal artery pedicle as reflux vein_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Yao , CHEN Buguo ^△ , DONG Ziqiang , YAN Chengshi , ZHENG Dawei ,  ZHU Hui

Department of Hand Microsurgery, Xuzhou Renci Hospital, Xuzhou Jiangsu, 221004, P.R.China;

Corresponding author：

ZHU Hui, Email: zhuhuirenci@126.com

Keywords：

Great toe fibular flap; free flap; distal phalanx finger wound

DOI：

10.7507/1002-1892.202009022

Video：

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Objective To investigate the effectiveness of the modified great toe fibular flap using the distal artery pedicle as reflux vein for repairing distal phalanx finger wound.Methods Between June 2018 and January 2020, 15 patients who suffered tissue defect of the distal phalanx finger were treated, including 12 males and 3 females, the average age was 40.2 years (range, 24-56 years). All of them were caused by machine crush injury. There were 2 cases of thumb, 6 cases of index finger, 3 cases of middle finger, 3 cases of ring finger, and 1 case of little finger. The defects ranged from 1.7 cm×1.3 cm to 3.0 cm×2.0 cm. The time from injury to admission was 0.6-4 hours, with an average of 2.3 hours. The medial fibular proper digital artery was further dissociated to the distal end and anastomosed with the recipient vein as the reflux vein. The area of flaps ranged from 2.0 cm×1.5 cm to 3.2 cm×2.2 cm.Results All the flaps survived without vascular crisis, and the wounds healed by first intention. Except for 1 case that the suture was too tight, the incision was partially split after the stitches were removed, and it healed spontaneously after dressing change, the other patients had good healing of the donor site incision and normal foot function. All 15 patients were followed up 3-18 months, with an average of 9.3 months. The appearance of finger pulps were satisfactory with full and threaded. The color, texture, and elasticity of the flaps were good, and the two-point discrimination was 6-8 mm at last follow-up. The flexion and extension of fingers were normal. At last follow-up, hand function was evaluated according to the upper limb function evaluation trial standard of the Chinese Medical Association Hand Surgery Society, and the results were 13 cases of excellent and 2 cases of good.Conclusion Modified great toe fibular flap using the distal arterial pedicle as a reflux vein can improve the venous drainage of the flap and contribute to increase the success rate of the flap without additional injury.

Citation： WU Yao, CHEN Buguo, DONG Ziqiang, YAN Chengshi, ZHENG Dawei, ZHU Hui. Repair of distal phalanx finger wound with modified great toe fibular flap with distal artery pedicle as reflux vein. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(2): 206-209. doi: 10.7507/1002-1892.202009022 Copy

1.	Liu C, Liu L, Liu G, et al. Repair of thumb defect by using the toenail flap: biomechanical analysis of donor foot-a retrospective cohort study. J Orthop Surg Res, 2019, 14(1): 287.
2.	Toros T, Gurbuz Y, Kelesoglu B, et al. Reconstruction of extensive pulp defects of the thumb with a radial-based pedicled flap from the index finger. J Hand Surg (Eur Vol), 2018, 43(10): 1036-1043.
3.	Elliot D, Adani R, Hyun Woo S, et al. Repair of soft tissue defects in finger, thumb and forearm: less invasive methods with similar outcomes. J Hand Surg (Eur Vol), 2018, 43(10): 1019-1029.
4.	Xuefeng Z, Jian G, Jiayue D, et al. Clinical effect of thumb finger reconstruction using dorsal foot flap transplant for treating thumb defects. Med Hypotheses, 2020, 134: 109435. doi: 10.1016/j.mehy.2019.109435.
5.	孙长胜, 李文君, 张玲玲, 等. 修薄的踇趾腓侧皮瓣移植修复手指指腹缺损. 中华显微外科杂志, 2017, 40(5): 464-466.
6.	王进, 赵光勋, 胡沣, 等. 带部分趾甲的踇趾腓侧瓣修复手指末端软组织合并甲床缺损 12 例. 中华显微外科杂志, 2019, 42(2): 117-119.
7.	Yuan C, Liu H, Zhang H, et al. Reconstruction of thumb pulp defects using free lateral great toe flaps. J Hand Surg (Am), 2020: S0363-5023(20)30573-6.
8.	熊秉刚, 欧翰杰, 陈健, 等. 拇趾腓侧微型组织瓣的解剖及临床应用. 中国美容整形外科杂志, 2013, 24(2): 95-97.
9.	周健, 杨孝明, 周丕育, 等. 应用游离拇趾腓侧皮瓣急诊修复拇指指腹创面. 中华整形外科杂志, 2014, 30(6): 464-465.
10.	Sun W, Wang Z, Qiu S, et al. Communicating branch of toe web veins as a venous return pathway in free toe pulp flaps. Plast Reconstr Surg, 2010, 126(5): 268e-269e.
11.	丰波, 镡云艳, 邹英财, 等. 趾腓侧游离皮瓣修复拇指和手指指腹缺损的疗效分析. 中华显微外科杂志, 2020, 43(4): 392-395.
12.	张兴奎, 张桂红, 吴加明, 等. 应用改良踇趾腓侧皮瓣游离修复拇指指腹缺损 12 例. 中华显微外科杂志, 2011, 34(3): 225-226.
13.	成亮, 陈铿, 柴益民, 等. 手指末节指掌侧浅静脉的显微解剖及临床应用. 中华显微外科杂志, 2011, 34(2): 131-133, 封3.
14.	潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
15.	糜菁熠, 芮永军, 寿奎水, 等. 改良踇趾腓侧皮瓣修复拇手指指腹缺损. 中华手外科杂志, 2006, 22(1): 32-33.
16.	Zheng X, Zhan Y, Li H, et al. Emergency repair of severe limb injuries with free flow-through chimeric anterolateral thigh perforator flap. Ann Plast Surg, 2019, 83(6): 670-675.
17.	方杰, 张文龙. 伴指固有动脉缺损的手指损伤修复进展. 中华解剖与临床杂志, 2020, 25(2): 202-207.
18.	Qing L, Wu P, Yu F, et al. Sequential chimeric deep circumflex iliac artery perforator flap and flow-through anterolateral thigh perforator flap for one-stage reconstruction of complex tissue defects. J Plast Reconstr Aesthet Surg, 2019, 72(7): 1091-1099.
19.	赵建军, 谢振军, 孙华伟, 等. 改良动脉静脉化在无静脉吻合甲根部以远离断再植中的应用. 中华手外科杂志, 2019, 35(6): 412-414.
20.	马建安, 赵晓航, 叶红禹, 等. 指尖离断再植 125 例临床体会. 中华手外科杂志, 2018, 34(4): 306-307.

1. Liu C, Liu L, Liu G, et al. Repair of thumb defect by using the toenail flap: biomechanical analysis of donor foot-a retrospective cohort study. J Orthop Surg Res, 2019, 14(1): 287.
2. Toros T, Gurbuz Y, Kelesoglu B, et al. Reconstruction of extensive pulp defects of the thumb with a radial-based pedicled flap from the index finger. J Hand Surg (Eur Vol), 2018, 43(10): 1036-1043.
3. Elliot D, Adani R, Hyun Woo S, et al. Repair of soft tissue defects in finger, thumb and forearm: less invasive methods with similar outcomes. J Hand Surg (Eur Vol), 2018, 43(10): 1019-1029.
4. Xuefeng Z, Jian G, Jiayue D, et al. Clinical effect of thumb finger reconstruction using dorsal foot flap transplant for treating thumb defects. Med Hypotheses, 2020, 134: 109435. doi: 10.1016/j.mehy.2019.109435.
5. 孙长胜, 李文君, 张玲玲, 等. 修薄的踇趾腓侧皮瓣移植修复手指指腹缺损. 中华显微外科杂志, 2017, 40(5): 464-466.
6. 王进, 赵光勋, 胡沣, 等. 带部分趾甲的踇趾腓侧瓣修复手指末端软组织合并甲床缺损 12 例. 中华显微外科杂志, 2019, 42(2): 117-119.
7. Yuan C, Liu H, Zhang H, et al. Reconstruction of thumb pulp defects using free lateral great toe flaps. J Hand Surg (Am), 2020: S0363-5023(20)30573-6.
8. 熊秉刚, 欧翰杰, 陈健, 等. 拇趾腓侧微型组织瓣的解剖及临床应用. 中国美容整形外科杂志, 2013, 24(2): 95-97.
9. 周健, 杨孝明, 周丕育, 等. 应用游离拇趾腓侧皮瓣急诊修复拇指指腹创面. 中华整形外科杂志, 2014, 30(6): 464-465.
10. Sun W, Wang Z, Qiu S, et al. Communicating branch of toe web veins as a venous return pathway in free toe pulp flaps. Plast Reconstr Surg, 2010, 126(5): 268e-269e.
11. 丰波, 镡云艳, 邹英财, 等. 趾腓侧游离皮瓣修复拇指和手指指腹缺损的疗效分析. 中华显微外科杂志, 2020, 43(4): 392-395.
12. 张兴奎, 张桂红, 吴加明, 等. 应用改良踇趾腓侧皮瓣游离修复拇指指腹缺损 12 例. 中华显微外科杂志, 2011, 34(3): 225-226.
13. 成亮, 陈铿, 柴益民, 等. 手指末节指掌侧浅静脉的显微解剖及临床应用. 中华显微外科杂志, 2011, 34(2): 131-133, 封3.
14. 潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
15. 糜菁熠, 芮永军, 寿奎水, 等. 改良踇趾腓侧皮瓣修复拇手指指腹缺损. 中华手外科杂志, 2006, 22(1): 32-33.
16. Zheng X, Zhan Y, Li H, et al. Emergency repair of severe limb injuries with free flow-through chimeric anterolateral thigh perforator flap. Ann Plast Surg, 2019, 83(6): 670-675.
17. 方杰, 张文龙. 伴指固有动脉缺损的手指损伤修复进展. 中华解剖与临床杂志, 2020, 25(2): 202-207.
18. Qing L, Wu P, Yu F, et al. Sequential chimeric deep circumflex iliac artery perforator flap and flow-through anterolateral thigh perforator flap for one-stage reconstruction of complex tissue defects. J Plast Reconstr Aesthet Surg, 2019, 72(7): 1091-1099.
19. 赵建军, 谢振军, 孙华伟, 等. 改良动脉静脉化在无静脉吻合甲根部以远离断再植中的应用. 中华手外科杂志, 2019, 35(6): 412-414.
20. 马建安, 赵晓航, 叶红禹, 等. 指尖离断再植 125 例临床体会. 中华手外科杂志, 2018, 34(4): 306-307.

Chinese Journal of Reparative and Reconstructive Surgery

Repair of distal phalanx finger wound with modified great toe fibular flap with distal artery pedicle as reflux vein

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